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Life | Wed Feb 24, 2016 4:36pm ESTRelated: HEALTHColombia reports 'probable' case of microcephaly in aborted fetusBOGOTA An Aedes Aegypti mosquito is seen in a lab of the International Training and Medical Research Training Center (CIDEIM) in Cali, Colombia February 2, 2016.REUTERS/JAIME SALDARRIAGA Colombian health officials reported on Wednesday a "probable" case of microcephaly possibly linked to Zika, as the country closely watches potential impacts of the mosquito-borne virus. The country's National Health Institute said Zika virus was identified in the amniotic fluid surrounding a severely deformed and aborted fetus. The abortion was performed on an 18-year-old mother when she was 28 weeks pregnant. Photographs were not taken of the fetus, but the doctor in Popayan, in the southwestern region of Cauca, had reported the fetus having an abnormally small head and considered it microcephaly, the institute, known as INS, said. Zika infection in pregnant women has not been proven to cause microcephaly in newborns. In Brazil, a huge spike in the birth defect followed the arrival of Zika last year, leading scientists to strongly suspect a link. Colombia has had its own Zika outbreak since October, and is monitoring pregnant women exposed to the virus, but has yet to cite a case of microcephaly. The Popayan case cannot be confirmed as microcephaly since the remains of the fetus were thrown away immediately after the abortion and tests could not be made, INS said. Traces of Zika were detected in the amniotic fluid, it said. "Unfortunately in this case, the breach of guidelines by those responsible for handling the case in Cauca prevented an accurate diagnosis being reached," Martha Lucia Ospina, director of the INS said in a statement. "They discarded the fetal remains that were indispensable to diagnose or rule out Zika and the link with microcephaly and other abnormalities." Brazil said it has confirmed more than 580 cases of microcephaly, and considers most of them to be related to Zika infections in the mothers. The country is investigating more than 4,100 additional suspected cases of microcephaly. Colombia - which has reported more than 37,000 cases of Zika including 6,356 in pregnant women - is seen as a key test case for the impacts of a Zika outbreak. The health minister last week said Colombia is reconsidering its own forecast of babies likely to be born with the rare birth defect linked to Zika. The government originally projected it could see some 500-600 cases of Zika-linked microcephaly. But it may take several more weeks, or months, for cases to emerge as signs of microcephaly may only be detected very late in pregnancy, experts say. There is no vaccine or treatment for Zika, which is a close cousin of dengue and chikungunya and causes mild fever, rash and red eyes. An estimated 80 percent of people infected have no symptoms. (Reporting by Helen Murphy and Luis Jaime Acosta; Editing by Bernard Orr)
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Colombian health officials reported on Wednesday a "probable" case of microcephaly possibly linked to Zika, as the country closely watches potential impacts of the mosquito-borne virus. The country's National Health Institute said Zika virus was identified in the amniotic fluid surrounding a severely deformed and aborted fetus. The abortion was performed on an 18-year-old mother when she was 28 weeks pregnant. http://www.reuters.com/article/us-health-zika-colombia-idUSKCN0VX2S9
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Map update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU
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Additional Cases of Travel-Related Zika Virus Confirmed In GeorgiaFebruary 25, 2016ATLANTA – The Georgia Department of Public Health (DPH) is confirming two additional travel-related cases of Zika virus in Georgia, bringing the total number of travel-related cases of Zika virus in the state to three. The non-pregnant individuals have both recovered. One individual traveled to Guatemala and El Salvador. The other individual traveled to Colombia. Test results are still pending on specimens from other Georgia residents with travel history to areas where Zika virus outbreaks are ongoing. Testing is being performed by the Centers for Disease Control and Prevention (CDC). DPH cautions travelers, especially women who are pregnant, headed to countries where Zika virus transmission is ongoing. The complete list of Zika affected countries can be found athttp://wwwnc.cdc.gov/travel/page/zika-travel-information. Currently, there is no vaccine to prevent or medicine to treat Zika. Travelers should check CDC travel advisories for their destinations and take precautions to protect themselves from mosquitos: Wear long-sleeved shirts and long pantsUse EPA-registered insect repellents containing DEET, picaridin, oil of lemon eucalyptus (OLE), or IR3535 (use as directed)Use permethrin-treated clothing and gear (such as boots, pants, socks, and tents)Stay and sleep in screened-in or air-conditioned roomsFor more information about Zika virus and current travel advisories, visitdph.georgia.gov or cdc.gov/zika.
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The Georgia Department of Public Health (DPH) is confirming two additional travel-related cases of Zika virus in Georgia, bringing the total number of travel-related cases of Zika virus in the state to three. The non-pregnant individuals have both recovered. One individual traveled to Guatemala and El Salvador. The other individual traveled to Colombia. http://dph.georgia.gov/press-releases/2016-02-25/additional-cases-travel-related-zika-virus-confirmed-georgia-0
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Zika virus is NOW linked to stillbirth, the complete loss of brain tissue and other abnormalitiesZika has already been linked to a defect causing abnormally small headsNow, scientists revealed it may also cause stillbirths and brain tissue lossA pregnant woman in Brazil delivered a stillborn baby in JanuaryThe baby had Zika and microcephaly (the defect that affects head size) It was also missing brain tissue and had dangerous fluid build-upScientists say stillbirths in Zika areas must be examined for similar defectsBy LISA RYAN FOR DAILYMAIL.COM PUBLISHED: 14:46 EST, 25 February 2016 | UPDATED: 17:02 EST, 25 February 2016 7shares15 View comments Reports of a stillbirth in Brazil suggests that the Zika virus may be linked to additional birth complications, experts have warned. In January, a pregnant woman infected with Zika delivered a stillborn child, it has emerged. The baby was missing a substantial portion of brain tissue, in addition to severe swelling and fluid build-up in other parts of the body. The woman didn't report any Zika symptoms - but the infection was found in the fetus, according to a case report. Thus, disease detectives need to take a closer look at stillbirths in Zika-affected areas, concluded a team of scientists from Yale University and the Hospital Geral Roberto Santos in Salvador, Brazil. +2The Zika virus has already been linked to microcephaly (pictured here on a baby) - a birth defect that results in an abnormally small head and brain damage. But now, scientists have also linked Zika to stillbirths, the absence of brain tissue and dangerous fluid build-up in babies Case study co-author Dr Albert Ko, of Yale, said: 'These finding raise concerns that the virus may cause severe damage to fetuses leading to stillbirths and may be associated with effects other than those seen in the central nervous system.' Zika has been spreading rapidly through Latin America. The virus raised global concern after Brazil saw a surge of babies born with a birth defect called microcephaly. RELATED ARTICLESPrevious1NextZika outbreak will 'get WORSE before it gets better', World...FOURTEEN new cases of possible sexual transmission of the...Zapping Zika: Officials will sterilize millions of...Gay man taking daily HIV prevention pills contracts...SHARE THIS ARTICLEShareThe defect causes babies to be born with unusually small heads - which can signal underlying brain damage. However, scientists are still working to determine if the mosquito-borne virus actually causes microcephaly. Yet, in several previously published studies, scientists found both the virus and serious brain abnormalities after fetal or newborn death. The case report could cause doctors to be on alert for other congenital problems - such as fluid build-up - during prenatal ultrasounds of at-risk women. The fluid build-up problem described in the study is called hydrops featalis. If hydrops fetalis alone is spotted in an ultrasound, 'you might not immediately attribute it to Zika virus because what has been described are brain abnormalities,' maternal-fetal viral infections expert Dr Sallie Permar, of Duke Human Vaccine Expert, told the Associated Press. Yet, the case suggests 'that this could be a systemic infection of the fetus, that not only the brain development could be affected,' Dr Permar added. An ultrasound of the stillborn in the case report showed no sign of trouble in the 14th week of pregnancy. +2Scientists warn that the mosquito-borne virus may be responsible for those additional defects. They urged disease defects to take a closer look at stillbirths in Zika-ravaged areas But, by 18 weeks, another ultrasound showed that the fetus was underweight. The woman's doctors detected a range of defects by week 30 - including microcephaly and hydrops featalis. And, two weeks later, the fetus died. The Zika virus was detected in brain tissue and amniotic fluid in subsequent testing. Dr Ko said: 'Additional work is needed to understand if this is an isolated finding and to confirm whether Zika virus can actually cause hydrops fetalis.' The Centers for Disease Control and Prevention have warned pregnant women - as well as those considering becoming pregnant - against traveling to Zika-affected areas. But if a pregnant woman has already traveled to at-risk regions, she can undergo tests to detect if she was infected. Ultrasound exams can also track fetal health. The case report was published in the journal PLOS Neglected Tropical Diseases. Read more: http://www.dailymail.co.uk/health/article-3464394/Stillbirth-offers-clue-possible-damage-Zika.html#ixzz41E3mH2GA Follow us: @MailOnline on Twitter | DailyMail on Facebook
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Zika threat to babies may be greater than thought after virus found in stillborn girlEpidemiologist warns that virus may affect not only the eyes and central nervous systems of foetuses, but may also cause swelling and death in the womb A pregnant woman holds a mosquito net. The discovery of the Zika virus in a stillborn baby girl raises concerns that the virus may cause severe damage to foetuses. Photograph: Luis Robayo/AFP/Getty ImagesIan SampleScience editor @iansampleThursday 25 February 2016 14.00 ESTLast modified on Thursday 25 February 201617.01 EST Share on PinterestShare on LinkedInShare on Google+Shares27 Save for laterDoctors fear that the Zika virus may pose a greater threat to unborn babies than previously thought, after tests on a stillborn girl in Brazil confirmed that she had the infection. The baby girl was delivered at 32 weeks after she died in the womb from a devastating combination of developmental problems that left her with a small head, almost no brain tissue and severe swelling throughout her body. Zika virus: link with two disorders expected to be confirmed within weeks Read moreThe virus, which has swept through the Americas, has already beenlinked to microcephaly, a condition that leaves children with small skulls, but not to more widespread abnormalities. More than 4,500 microcephaly cases have been reported to Brazilian health authorities since the mosquito-borne virus began to spread through the country early last year. The mother of the child, a 20-year-old Brazilian, was referred to doctors after an ultrasound scan at 18 weeks found that her baby had stopped growing normally. Follow-up examinations in her second and third trimesters revealed the full extent of the baby’s defects. She was delivered weighing only 2lbs. Albert Ko, an epidemiologist at Yale University and leader of the investigating team, said the case served as “an alert to clinicians” that the virus may affect not only the eyes and central nervous systems of unborn babies, but may also cause dangerous swelling and death in the womb. “These findings raise concerns that the virus may cause severe damage to foetuses leading to stillbirths and may be associated with effects other than those seen in the central nervous system,” he said. Further work will be needed to understand whether the stillbirth was an isolated case, and whether the virus can cause the accumulation of fluids that led to such severe swelling in the child. “Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk,” Ko and his colleagues write in the journal Plos Neglected Tropical Diseases. WHO paves way for use of genetically modified mosquitoes to combat Zika Read moreThe girl’s mother was referred to doctors after a large outbreak of Zika virus in the coastal city of Salvador. Before and during pregnancy, she did not report any of the usual symptoms of Zika infection, such as rash, fever and aches. But Ko points out that nearly three quarters of Zika infections do not produce symptoms, so many infections go undetected. After inducing the birth, doctors analysed tissues from the baby girl and confirmed the presence of the virus. The strain is believed to be the one that is currently spreading through the region. The alert comes a month after senior doctors warned that the Zika virus could pose a major threat to public health. Speaking ahead of an emergency meeting of the World Health Organisation, convened to decide whether the outbreak should be rated as a global health crisis, Jeremy Farrar, head of the Wellcome Trust, said: “It is a silent infection in a group of highly vulnerable individuals – pregnant women – that is associated with a horrible outcome for their babies.” http://www.theguardian.com/world/2016/feb/25/zika-threat-to-babies-may-be-greater-than-thought-after-virus-found-in-stillborn-girl
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Zika virus case confirmed in SaskatchewanZika virus disease is caused by a virus transmitted by Aedes mosquitoesCBC News Posted: Feb 25, 2016 4:25 PM CT Last Updated: Feb 25, 2016 4:25 PM CT A case of Zika Virus has been confirmed in Saskatchewan. The Public Health Agency of Canada has confirmed the province's first case of Zika virus on Thursday afternoon. According to a release from the Government of Saskatchewan, public health officials have been doing all the necessary case follow-up work in the province, notifying the person, and their physicians. The province's Medical Health Officer, Dr Saqib Shahab will be speaking with media on Friday. The province could not provide details about the location of the confirmed case. Pregnant women in Canada, U.S., urged to postpone travel to Zika-hit countriesZika virus outbreak an emergency, World Health Organization saysZika virus: 6 things to know about the growing outbreakThe Zika virus is spread by mosquito bites and causes mild infections. But there's mounting evidence linking it to a birth defect in Brazil. Zika infection in pregnant women is associated with a rare condition called microcephaly, in which the head is smaller than normal and the brain doesn't develop properly. The virus is transmitted by Aedes mosquitoes, which are not found in Canada. http://www.cbc.ca/news/canada/saskatchewan/zika-virus-case-in-sask-1.3464643
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Map update https://www.google.com/maps/d/edit?hl=en&hl=en&authuser=0&authuser=0&mid=zv94AJqgUct4.kT4qLMXp3SLU
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There have been 4 lab-confirmed cases of Zika in Alberta, 1 in 2013 and 3 in 2016.All cases were acquired due to travel and the returning travellers do not pose a risk to public health in Alberta.http://www.health.alberta.ca/health-info/zika-virus.html
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3 new cases of Zika confirmed in CanadaA government worker fumigates for the Aedes aegypti mosquito in Veracruz, Panama, on Thursday, Feb. 25, 2016. (AP Photo/Arnulfo Franco) 9 9 0 CTVNews.ca Staff Published Thursday, February 25, 2016 4:06PM EST Three new cases of Zika virus have been confirmed in Canada, federal health officials tell CTV News. The new cases are in Saskatchewan, Ontario and Alberta. Details on age and sex were not provided. Ontario’s public health agency confirmed last Friday that one person in that province had tested positive for Zika after traveling to Colombia. RELATED STORIESOntario confirms its first case of Zika virusZika: 3 Canadians infected as WHO warns virus is 'spreading explosively'Alberta Health has identified at least four lab-confirmed cases there: one in 2013 and three in 2016. In late January, the BC Centre for Disease Control confirmed two cases of Zika in British Columbia: one in a person who had been to El Salvador and the other in a person who had traveled to Colombia. Most of those infected with Zika do not develop symptoms, and those who become ill generally have only a minor fever, rash, eye problems and/or joint pain. However, the virus has prompted an emergency warning from the World Health Organization, because of mounting evidence in Brazil that the virus is causing thousands of babies born with abnormally small heads, a condition known as Microcephaly. The risk to Canadians who do not travel to one of 48 infected countries or territories is considered very low. That’s because the type of mosquitoes that spread Zika don’t thrive in Canada, according to Dr. David Williams, Ontario's Chief Medical Officer of Health. With files from The Canadian Press http://www.ctvnews.ca/health/3-new-cases-of-zika-confirmed-in-canada-1.2792954?hootPostID=f2a25787ef8957eca554aa2071dcf491
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http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/zika-virus/surveillance-eng.php?id=zikacases#s1 Zika virus cases in Canada, as of February 25, 2016 CountryLocally acquiredTravel-relatedCanada014
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How many cases are there of Zika virus in Canada?As of February 25, 2016, 14 travel-related cases of Zika virus have been reported in Canada. The case counts will be updated on Mondays and Thursdays. The next update will be made on Monday, February 29, 2016. Currently, neither of the mosquitoes that transmit Zika virus is found in Canada due to the climate. So, there is a very low probability of transmission in Canada. To date, there have been no reported cases of locally acquired Zika virus in Canada. Current evidence suggests that Zika virus is likely to persist and spread in the Americas and the South Pacific. There is ongoing risk to Canadians travelling to endemic regions. Zika virus cases in Canada, as of February 25, 2016CountryLocally acquiredTravel-relatedCanada014
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How many cases are there of Zika virus in Canada?As of February 25, 2016, 14 travel-related cases of Zika virus have been reported in Canada. The case counts will be updated on Mondays and Thursdays. The next update will be made on Monday, February 29, 2016. http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/disease-maladie/zika-virus/surveillance-eng.php?id=zikacases#s1
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Stillbirth offers another clue to possible damage from ZikaBy: Lauran Neergaard, The Associated PressPosted: 02/25/2016 1:18 PM | Last Modified: 02/25/2016 1:40 PM | Comments: 0 Tweet 0 Post 0 Reddit 0 ShareThis 0 Print Email 0WASHINGTON - A stillbirth in Brazil is offering another clue to possible health effects of the Zika virus, this time beyond the developing brain. In addition to a devastating loss of brain tissue, this fetus also had another abnormality — severe swelling and fluid build-up in other parts of the body — that by itself can be life-threatening, researchers reported Thursday. Researchers found the Zika virus in the fetus even though the mother didn't report any symptoms of infection, according to the case report published in the journal PLOS Neglected Tropical Diseases. Disease detectives should take a closer look at stillbirths in Zika-affected areas, concluded the team from Yale University and the Hospital Geral Roberto Santos in Salvador, Brazil. Zika is spreading rapidly through Latin America and raised global concern after Brazil reported a surge in babies born with unusually small heads, a birth defect called microcephaly that can signal underlying brain damage. Whether the mosquito-borne Zika really causes microcephaly isn't yet proven. But in a handful of previously published cases, researchers have found both the virus and serious brain abnormalities after fetal or newborn death. Thursday's report could alert doctors to watch for other congenital problems — like the fluid build-up cited in the study — during prenatal ultrasound exams of women potentially at risk. The fluid problem is called hydrops fetalis. If a doctor spotted hydrops alone, "you might not immediately attribute it to Zika virus because what has been described are brain abnormalities," said Dr. Sallie Permar of the Duke Human Vaccine Institute, an expert on maternal-fetal viral infections who wasn't involved with the Brazil case. The case raises the possibility "that this could be a systemic infection of the fetus, that not only the brain development could be affected," Permar added. With the stillbirth, an ultrasound showed no sign of trouble in the 14th week of pregnancy — but at 18 weeks, another ultrasound found the fetus weighed too little, the Yale-Brazil team reported. Doctors could detect a range of defects by week 30, including microcephaly and the fluid problem. Two weeks later, the fetus died. Subsequent testing detected the Zika virus' genetic material in brain tissue and amniotic fluid. U.S. health officials say pregnant women or those considering becoming pregnant shouldn't travel to Zika-affected areas. If pregnant women already travelled to at-risk areas, they can undergo certain tests to try to detect if they were infected, as well as ultrasound exams to track fetal health. http://www.winnipegfreepress.com/arts-and-life/life/health/stillbirth-offers-another-clue-to-possible-damage-from-zika-370150751.html
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References1.Campos GS, Bandeira AC, Sardi SI (2015) Zika Virus Outbreak, Bahia, Brazil. Emerg Infect Dis 21: 1885–1886. doi: 10.3201/eid2110.150847. pmid:26401719View ArticlePubMed/NCBIGoogle Scholar2.Zanluca C, de Melo VC, Mosimann AL, Dos Santos GI, Dos Santos CN, et al. (2015) First report of autochthonous transmission of Zika virus in Brazil. Mem Inst Oswaldo Cruz 110: 569–572. doi: 10.1590/0074-02760150192. pmid:26061233View ArticlePubMed/NCBIGoogle Scholar3.Fauci A, Morens D (2016) Zika Virus in the Americas—Yet Another Arbovirus Threat New Engl J Med Published online January 13, 2016. doi: 10.1056/nejmp1600297View ArticlePubMed/NCBIGoogle Scholar4.Brazil Ministry of Health (2016) Microcephaly–Ministry of Health releases epidemiological bulletin. Epidemiological report N 11. Epidemiological Week 04/2016 (24 to 30 Jan, 2016)http://portalsaude.saude.gov.br/images/pdf/2016/fevereiro/03/COES-Microcefalias—Informe-Epidemiol—gico-11—SE-04-2016—02FEV2016—18h51-VDP.pdf (accessed Fev 05, 2016; in Portuguese).5.Oliveira Melo AS, Malinger G, Ximenes R, Szejnfeld PO, Alves Sampaio S, et al. (2016) Zika virus intrauterine infection causes fetal brain abnormality and microcephaly: tip of the iceberg? Ultrasound Obstet Gynecol 47: 6–7. doi: 10.1002/uog.15831. pmid:26731034View ArticlePubMed/NCBIGoogle Scholar6.Mlakar J, Korva M, Tul N, Popovic M, Poljsak-Prijatelj M, et al. (2016) Zika Virus Associated with Microcephaly. N Engl J Med. doi: 10.1056/nejmoa1600651View ArticlePubMed/NCBIGoogle Scholar7.Martines R, Bhatnagar J, Keating M, Silva-Flannery L (2016) Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses—Brazil, 2015. MMWR Morb Mortal Wkly Rep 2016;65(Early Release):1–2 doi: http://dxdoiorg/1015585/mmwrmm6506e1e 65.View ArticlePubMed/NCBIGoogle Scholar8.Balm MN, Lee CK, Lee HK, Chiu L, Koay ES, et al. (2012) A diagnostic polymerase chain reaction assay for Zika virus. J Med Virol 84: 1501–1505. doi: 10.1002/jmv.23241. pmid:22825831View ArticlePubMed/NCBIGoogle Scholar9.de Paula Freitas B, de Oliveira Dias JR, Prazeres J, Sacramento GA, Ko AI, et al. (2016) Ocular Findings in Infants With Microcephaly Associated With Presumed Zika Virus Congenital Infection in Salvador, Brazil. JAMA Ophthalmol. doi: 10.1001/jamaophthalmol.2016.0267. pmid:26865554View ArticlePubMed/NCBIGoogle Scholar10.Duffy MR, Chen TH, Hancock WT, Powers AM, Kool JL, et al. (2009) Zika virus outbreak on Yap Island, Federated States of Micronesia. N Engl J Med 360: 2536–2543. doi: 10.1056/NEJMoa0805715. pmid:19516034View ArticlePubMed/NCBIGoogle Scholar11.Enfissi A, Codrington J, Roosblad J, Kazanji M, Rousset D (2016) Zika virus genome from the Americas. Lancet 387: 227–228. doi: 10.1016/S0140-6736(16)00003-9. pmid:26775124View ArticlePubMed/NCBIGoogle Scholar
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DiscussionAttention has focused on the deleterious effects that the ZIKV may have on fetuses due to the rapid global spread of virus and the current outbreak of microcephaly in Brazil. ZIKV has been detected in a small number of cases of fetuses and newborns with microcephaly who have been identified during the outbreak [5–7]. This case report of a fetus provides additional evidence for the link between ZIKV infection and microcephaly. Furthermore, it serves as an alert to clinicians that in addition to central nervous system and ophthalmological manifestations [6,7,9], congenital ZIKV infection may cause hydrops fetalis and fetal demise. Since the majority (73%) of ZIKV infections are asymptomatic [10], it is likely that exposures in pregnant women, such as in the case of our patient, often go unnoticed. We could not document acute infection in the mother and discard the possibility, albeit unlikely, that the severe manifestations, observed in this case, was caused by another process and intrauterine ZIKV infection occurred afterwards. The first indication of an abnormal pregnancy was the ultrasound finding of intrauterine growth retardation in the 18th gestational week. The more plausible explanation is that asymptomatic exposure of the mother, prior to this date and likely in the 1st trimester, caused an intrauterine infection which in turn, resulted in hydranencephaly and hydrops fetalis in the fetus. The finding of an association between ZIKV infection and hydrops fetalis suggests that the virus may cause damage to tissues in addition to the fetal central nervous system. Recent autopsy studies found that histopathologic findings and detection of ZIKV in newborns and fetuses with microcephaly were limited to the brain and in some cases, placenta [6,7], indicating that the virus, unlike common congenital viral infections, exhibits tropism to a limited range of tissues. We detected ZIKV RNA in the central nervous system and amniotic fluid and not in heart, lung, liver or placenta, yet our findings were limited by the sampling procedure and lack of histopathological analysis of tissues. The mechanism by which ZIKV may cause hydrops fetalis therefore remains speculative. We cannot extrapolate from this single case the overall risk for developing hydrops fetalis and fetal demise among pregnant women exposed to the virus. The strain detected in this case of fetal demise appears to be the same as the epidemic strain that has spread across the Americas and Caribbean [6,11]. Given that large numbers of pregnant women in the region have been or will be exposed to this strain, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes. AcknowledgmentsWe thank Adriana Monte MD, Rodrigo Adry MD, Igor Ferreira Viera MD and Milla Dias Sampaio MD, from Hospital Geral Roberto Santos and Jaqueline Cruz MS, Laiara Lopes and Isadora Siqueira MD, PhD from the Oswaldo Cruz Foundation, who provided care for the patient and assisted in the implementation of this study. We also thank Luiz Carlos Alcântara PhD, Mitermayer G. Reis MD, PhD and Manoel Barral Netto MD, PhD from the Oswaldo Cruz Foundation, and Shannan Rossi, PhD and Scott Weaver, PhD from University of Texas Medical Branch for their support in performing the laboratory evaluation and developing the diagnostic platforms. Author ContributionsConceived and designed the experiments: MS MSdR ARPdA. Performed the experiments: MS MSdR ARPdA GA. Analyzed the data: MS MSdR ARPdA GAS RK FC LAS AIK NN. Contributed reagents/materials/analysis tools: MS ARPdA FC LAS AIK NV. Wrote the paper: MS FC LAS AIK ARPdA.
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Results We assumed the care for a 20-year-old woman (gravida 3, para 1) in the 18th week of gestation whose ultrasound examination showed low fetal weight. The patient procured prenatal care during the 4th gestational week in July, 2015 at which time she was found to have a negative serology for HIV, HTLV and hepatitis C viruses and positive IgG and negative IgM ELISA results for toxoplasmosis, rubella virus and cytomegalovirus. She had an uneventful course of pregnancy with a normal ultrasound evaluation at the 14th gestational week. In the 18th week, ultrasound examination found that the fetus had a weight three standard deviations below the mean value for gestational age. On referral, the patient did not report an episode of rash, fever, or body pain or receiving a diagnosis for zika, chikungunya or dengue virus infection during the pregnancy. She denied a family history of an illness suggestive of a Zika virus infection or congenital disorders. Her clinical evaluation was unremarkable. Ultrasound examinations performed at the 26th and 30thgestational weeks showed microcephaly, hydranencephaly with minimal residual cortical parenchyma (Fig 1, Panel A), intracranial calcifications and destructive lesions of posterior fossa (Fig 1, Panel B). The examinations were also significant for the findings of hydrothorax, ascites and subcutaneous edema (Fig 1, Panels C and D). Download:PPTPowerPoint slidePNGlarger image (3.41MB)TIFForiginal image (2.52MB)Fig 1. Axial ultrasound views of the fetus at the 30th gestational week showing (A) Cranium with severe microcephaly (215mm) and hydranencephaly; (B) Posterior fossa with destruction of the cerebellar vermis (wide arrow) and nuchal edema (thin arrow); (C) Thorax with bilateral pleural effusions (arrow); and (D) Abdomen with ascites (wide arrow) and subcutaneous edema (thin arrow). doi:10.1371/journal.pntd.0004517.g001 An induced labor was performed when ultrasound examination in the 32nd gestational week showed fetal demise and delivered a female fetus with a weight of 930g and signs of microcephaly and arthrogryposis. We obtained ZIKV-specific RT-PCR amplification products from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid. Analysis of extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products. Amplification products mapped within the NS5 gene of ZIKV strains belonging to the Asian lineage, with closest relationship to sequences from French Polynesian and Surinamese strains. The patient gave consent to have her case details published.
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Methods While conducting an outbreak investigation in Salvador, Brazil, we identified a patient who was referred to Hospital Geral Roberto Santos with an abnormal fetal ultrasound examination and followed during outpatient evaluations. After fetal demise and induced labor, tissues aspirates and fragments were collected by needle aspiration and thoraco-abdominal viscerotomy, respectively, since an autopsy could not be performed. RNA was extracted and tested by a ZIKV-specific reverse transcriptase-polymerase transcriptase assay (RT-PCR) [8].
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Introduction The current outbreak of microcephaly has raised speculations that Zika virus (ZIKV) causes a congenital syndrome. ZIKV, a mosquito-borne flavivirus, was detected in Brazil in early 2015 [1,2] and has rapidly spread throughout the Americas [3]. A large increase in the number of newborns with microcephaly was subsequently identified in Brazil in November 2015. At present, more than 4,500 microcephaly cases have been reported [4]. ZIKV has been detected in few cases, seven in total to date, of fetuses and newborns who died shortly after birth, all of whom had ultrasound abnormalities or pathological lesions which were restricted to the central nervous system [5–7]. Herein, we report a case of a fetus that in addition to hydranencephaly, developed hydrops fetalis and fetal demise in association with congenital ZIKV infection.
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AbstractBackgroundThe rapid spread of Zika virus in the Americas and current outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses. Methodology/Principal FindingsWe report a case of a 20-year-old pregnant woman who was referred to our service after a large Zika virus outbreak in the city of Salvador, Brazil with an ultrasound examination that showed intrauterine growth retardation of the fetus at the 18th gestational week. Ultrasound examinations in the 2nd and 3rd trimesters demonstrated severe microcephaly, hydranencephaly, intracranial calcifications and destructive lesions of posterior fossa, in addition to hydrothorax, ascites and subcutaneous edema. An induced labor was performed at the 32nd gestational week due to fetal demise and delivered a female fetus. ZIKV-specific real-time polymerase chain reaction amplification products were obtained from extracts of cerebral cortex, medulla oblongata and cerebrospinal and amniotic fluid, while extracts of heart, lung, liver, vitreous body of the eye and placenta did not yield detectable products. Conclusions/SignificanceThis case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes. Author SummaryThe rapid spread of Zika virus in the Americas and outbreak of microcephaly in Brazil has raised attention to the possible deleterious effects that the virus may have on fetuses. We report a case of a 20-year-old pregnant woman from Salvador, Brazil whose fetus had developed hydrops fetalis, a condition where there is abnormal accumulation of fluid in the fetus, as well as severe central nervous system defects such as microcephaly and hydranencephaly. After fetal demise, ZIKV RNA was detected in central nervous system tissues and amniotic fluid. The case report provides evidence that in addition to microcephaly, there may be a link between Zika virus infection and hydrops fetalis and fetal demise. Given the recent spread of the virus, systematic investigation of spontaneous abortions and stillbirths may be warranted to evaluate the risk that ZIKV infection imparts on these outcomes. Figures Citation: Sarno M, Sacramento GA, Khouri R, do Rosário MS, Costa F, Archanjo G, et al. (2016) Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise. PLoS Negl Trop Dis 10(2): e0004517. doi:10.1371/journal.pntd.0004517 Editor: Peter J. Hotez, Baylor College of Medicine, Texas Children's Hospital, UNITED STATES Received: February 16, 2016; Accepted: February 16, 2016; Published: February 25, 2016 Copyright: © 2016 Sarno et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability: All data will be available in the manuscript. Funding: The authors received no specific funding for this work. Competing interests: The authors have declared that no competing interests exist.
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Published: February 25, 2016DOI: 10.1371/journal.pntd.0004517ArticleAuthorsMetricsCommentsRelated ContentAbout the AuthorsManoel Sarno, Mateus S. do Rosário, Gracinda Archanjo, Antonio R. P. de Almeida Hospital Geral Roberto Santos, Secretaria Estadual da Saúde da Bahia, Salvador, Bahia, Brazil Manoel Sarno, Federico Costa, Antonio R. P. de Almeida Faculdade de Medicina da Bahia and Instituto da Saúde Coletiva, Universidade Federal da Bahia, Salvador, Bahia, Brazil Gielson A. Sacramento, Ricardo Khouri, Federico Costa, Luciane A. Santos, Nivison Nery Jr., Albert I. Ko Centro de Pesquisas Gonçalo Moniz, Fundação Oswaldo Cruz, Ministério da Sáude, Salvador, Bahia, Brazil Federico Costa, Albert I. Ko Department of Epidemiology of Microbial Diseases, Yale School of Public Health, New Haven, Connecticut, United States of America Nikos Vasilakis Department of Pathology and Center of Biodefense and Emerging Infectious Diseases, Institute for Human Infections and Immunity, The University of Texas Medical Branch, Galveston, Texas, United States of America Corresponding [email protected]
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Zika Virus Infection and Stillbirths: A Case of Hydrops Fetalis, Hydranencephaly and Fetal Demise Manoel Sarno,Gielson A. Sacramento,Ricardo Khouri,Mateus S. do Rosário,Federico Costa,Gracinda Archanjo,Luciane A. Santos,Nivison Nery Jr.,Nikos Vasilakis,Albert I. Ko ,Antonio R. P. de Almeida Published: February 25, 2016DOI: 10.1371/journal.pntd.0004517 http://journals.plos.org/plosntds/article/authors?id=10.1371%2Fjournal.pntd.0004517
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Belmont County Woman Officially Contracts Zika VirusPosted: Feb 25, 2016 2:10 PM ESTUpdated: Feb 25, 2016 3:00 PM EST Belmont County, Ohio -Officials with the Belmont County Health Department were notified Thursday morning a woman in county tested positive for the Zika Virus. It is the first case of an Ohio Valley resident being infected with the Zika virus. According to Health Department officials, the woman came down with symptoms - including fever, aches and conjunctivitis. Officials say she is not of childbearing years. She was tested at a hospital in the Wheeling area, and per protocol, they sent the sample to the Center for Disease Control. Officials with the Health Department said the patient had traveled to a Haiti, where Zika transmission has been active and ongoing. She is now fully recovered and is perfectly fine. Both health departments encourage residents who have questions about how their travel histories might affect their risk to consult their physicians. http://www.wtrf.com/story/31317156/belmont-county-woman-officially-contracts-zika-virus